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fortunate man who has been operated on that was caused by chancre in the urethra eight times will recover. I shall present him about one-half inch from the meatus. to you on next Saturday at my clinic, when Stricture of the urethra is a disease of the you will be surprised at the good results of female as well as of the male, and at all periods antiseptic surgery.
of life, although men are more liable to it
than women. Stricture of the Urethra----Diagnosis and
No part of the urethra is exempt from it Treatment.
except the prostatic portion, or if it should be
found in this region it would be a very rare ocRead before the Eastern Kansas District Med
currence and statistics show by the experience
of some authors that they never encountered ical Society, in Osage City, Jan. 14, 1890.
a stricture in this region. The seat of this
disease has been very carefully studied by Sir BY WM. A. RIGHTER, M. D., TOPEKA.
Henry Thompson, who has availed himself of The causes of stricture of the urethra may
the advantage afforded him by the public colbe conveniently arranged in two forms, the lections in London, Edinburg and Paris. The traumatic and the pathological stricture, of number of specimens examined were 270 em
Of these 215, which the latter is the most frequent. The bracing 320 distinct strictures. term traumatic is applied to that form of stric- or 67 per cent. were situated at the sub-pubic ture which is caused by injury, the pathologi- curvature and its vicinity, or the junction of cal stricture is caused by disease.
membraneous and spongy portions and one Injury inflicted upon the urethra internally inch of the canal before, and 34 of an inch beor externally, may cause inflammation suffi- hind the triangular ligament; fifty-one, or sixcient to cause stricture. A penetrating wound teen per cent. in the centre of the spongy of the urethra may produce a stricture of portion; and fifty-four, or seventeen per cent. the most obstinate variety.
at the external orifice, and within two and oneThe kind of injury that usually produces a half inches of that point. He found that strictraumatic stricture is either a blow, kick or ture was the most frequent in the bulbous fall upon the perineum, causing a contusion parts of the spongy portion, and the least freor larceration of the mucous membrane and quent of all at the posterior part of the memthe subjacent tissues of the urethra. The branous portion. In 226 cases the stricture violent use of a bougie in the hands of an un- was single and in 185 of these it occupied the skilled operator may and has caused stricture posterior region; in seventeen the middle of the urethra. Masturbation is a cause of region, and in twenty-four the anterior region. stricture as cited by the experience of S. W. In eight cases, the canal was obstructed in Gross of Philadelphia, at the House of Refuge all of these regions, in ten in the first and and the Insane asylum.
second only, in ten in the first and third only, The most frequent cause of pathological and in thirteen in the second and third regions stricture is gonorrhea, frequent or obstinate only. Usually there is only one stricture, but attacks of gonorrhæa are more liable to pro
often there are two or three, and many more; duce stricture than one attack. Inflammatory Gross, never saw but four in one patient, but matter is thrown out more or less, and con
Hunter saw six; Lallemand seven ; Colto, traction of the urethra is the result. Urethri- eight; Lery eleven; and Otis saw fourteen. tis caused by non-specific female discharges, Although I have had quite an experience in caustic's, strong injections, over indulgence in the treatment of stricture of the urethra, three sexual intercourse are liable to cause stricture. is the greatest number I have encountered.
Prof. Gross says that in his experience 90 Strictures are of different varieties. I think per cent. of all urethral strictures are due to the most common form is the linear stricture, gonorrhea, and I believe it true because all the which presents an appearance as though the strictures that come under my observation have urethra was constricted by a cord. It embeen caused by gonorrhæa except one, and braces the entire circumference of the canal at the point of the stricture, and forms a sort describing all of the symptoms that are proof a partition or septum (which is perforated) duced by stricture of the urethra, but will say as it might be called, thus dividing the ure that these are not (especially these symptoms I thra, but linear stricture does not always form have mentioned,) pathognomonic of stricture, in this way although it will form in a crescentic because they may be caused by some other fold on one side of the canal.
disease; but it devolves upon all of us to make There is another form of stricture formed a correct diagnosis of such cases, and to do by a narrow band extending across the canal that, you must explore the urethra with an and is called a bridle stricture.
instrument which is capable of locating the Annular stricture involves the surrounding stricture. I have never depended upon the structures much deeper and varies in length. catheter or bougie to locate the stricture, beA stricture of this variety has been observed cause they sometimes produce spasm of the from one end of the urethra to the other. urethra, which is called a spasmodic stricture; This is the variety of stricture that becomes I have therefore, always used Leroy's exploraindurated and extensive hardening caused by tory bulbous bougie, which will never fail to all of the tunics of the urethra becoming in- give you the exact location and the length of volved and the contraction is the greatest at the stricture. After I pass this instrument its centre. If any of you have seen one of into the bladder, and then very carefully and these glasses that is contracted in its centre, slowly withdraw it, if there are any stricand which is used for timing a boiling egg, I tures, the bulb of the instrument will be held believe it is called an hour glass, you will have rather firmly behind the obstruction or it will seen an annular stricture.
jump over, which sensation can very precepThere is a tortuous stricture which causes tibly be felt by the operator. A mark may the canal to be of a different direction instead be made upon the instrument with the thumb of being as it should be, thus foiling an attempt nail as the strictures are located one after anothto pass any instrument. It may be indurated er which can be measured with a rule or tape or not, the passage of an instrument may be line after the instrument is withdrawn. This completely foiled.
part of the diagnosis must be done very genThere is an impermeable stricture so called, tly as well as deliberately, so as to avoid spasm but when the urine passes in drops it is not, or any undue pain or suffering to the patient. Strictly, an impermeable stricture. It is
TREATMENT OBSERVATIONS. given this name because the smallest instru
In regard to the treatment of stricture of ment cannot be passed through it.
the urethra it has been revolutionized as well An impermeable stricture is one that will as other parts of medicine and surgery. Here not permit the passage of urine, is rather rare antiseptics come into use as well as in general or we may say uncommon; such a stricture
surgery. will produce dilatation of the urethra back of
After the strictures are located a catheter, the stricture and forms a urinary cyst, which the size that will enter the meatus to the hindmight produce urinary fistula.
ermost stricture should be passed. Attach to it A gleety discharge is usually the first symp- a rubber bulb syringe and wash out the urethra tom the patient notices and he may not have pretty thoroughly with a solution of boracic any other symptom. A narrow stream of acid before attempting to operate. If the urine, a bi-furcated, or a flat stream, or in the hindermost stricture is not more than four and form of a cork screw, a check in the desire, or three-fourths inches from the meatus I introwhile urinating, dribbling. Hyperasthesia of duce a urethratome (Gross) and divide every the urethra, thus causing frequent desire to stricture that has been located. I have dividurinate, and pain with a feeling of weight at ed a stricture on two sides, but once is usually the neck of the bladder, and retention and sufficient; then as large a bougie as the exterincontinence of urine are some of the symp- nal meatus will accommodate is passed every toms.
two or three days until pain and soreness has I do not wish to consume too much time in passed away. After about thirty days you
may satisfy yourself by another exploration Written for the Medical Journal. that your patient has fully recovered. A stric
Knife Wound of the Stomach. ture of large calibre may be satisfactorily treated by divulsion and followed by the bougie.
I have been in the habit of performing internal urethrotomy for stricture of the urethra
October 25, 1889, I was hastily called to see any where in its track; but as you all may
J. E. P—, aged 30, who during an altercaknow that if a stricture is beyond four and tion received a knife wound of the abdomen. three-fifths to five inches, is cut or divulsed He was suffering intense pain and vomiting from the inside, chill and fever is the result and I gave him a hypodermic injection of and is termed in these days of enlightenment morphia. He had just ate his dinner and septic absorption, or septicæmia. Therefore vomited freely, but there was no trace of external urethrotomy is performed before the blood in the ejecta. As soon as he was easy anterior strictures are operated upon.
he was removed to his home and the wound semale catheter is passed into the bladder
was examined. through the perineal wound, then internal
The external wound was one inch long, urethrotomy is performed upon all anterior extending from the linea alba downward and strictures. After the strictures have all been to the left, beginning two and one-half inches previously made aseptic, a bougie is passed below the ensiform cartilage. into the bladder, the female catheter of course
A probe was passed into the wound directed is removed to allow the bougie to enter, a
slightly upwards three and one-half inches, drainage tube is then inserted into the bladder followed on its withdrawal by a greasy subthrough the perineal wound which is allowed stance similar to that immediately vomited. to remain twenty-four hours. A bougie is
I advised an operation as the only course of then passed every two or three days until the procedure. perineal wound is healed which requires not
Assisted by Drs. Nichols, Smith and Harris more than two weeks, if the case progresses as
the patient was etherized and I operated. you would anticipate.
First having cleansed the wound and abdomen Urethral chills are supposed to be caused
with a bi-chloride solution, I made an incision by septic absorption through the urethral
in the linea alba three inches in length bewound. If an internal urethrotomy
ginning two inches below the ensiform carti
is performed in the pendulous portion of the urethra lage. Several small pieces of beef-steak were the wound will drain well, whereas, in a case
found which had escaped from the stomach of an internal urethrotomy in the deep urethra, during the act of vomiting. the wound will not drain; there follows ab
The wound in the stomach was found with sorption, chills, fever, ctc., and you would say considerable difficulty and was one and oneyour patient has urethral fever. When at the fourth inches long. Situated two and one-half same time you were not aware of the fact inches from the cardiac orifice and one and that your patient had septicæmia which would one-half inches from the omental fold. On be a very unfortunate occurence.
removing the clotted blood from the wound Electricity has been highly lauded in the two smali arteries which had been severed bepast few years in the treatment of stricture, gan bleeding, but were closed by torsion and but I have never had any confidence in it,
the wound closed by a continuous carbolized therefore I have never tried it, and I am ac
silk ligature (cat gut could not be obtained.) quainted with a number of men who have
The external wound was closed by six ingiven electricity a thorough trial and are terrupted sutures and dusted with iodoform. abandoning it.
A hypodermic injection of whisky was given before and after the operation to assist reaction,
which was complete. He was nourished per Do not pour sulphuric ether from one ves- rectum by beef extract and whisky, and sel to another near a lighted lamp or gas jet. sufficient morphia given hypodermically to
relieve the pain. The patient was very hope SOCIETY PROCEEDINGS. ful and had a good night's rest.
October 26—-The pulse ranged about 120 Eastern Kansas District Medical Society. but the temperature was normal. October 27-Morning, temperature 102°,
The Eastern Kansas District Medical Sopulse 130. Evening, temperature 99°, pulse ciety met in Dr. Schenck's office, in Osage 140, slight tympanites; urine drawn.
City, January 14, 1890, at 3 o'clock, p. m. October 28—From four to five a. m. very Present--Drs. Minney, Schenck, Righter, restless with some delirium. At nine a. m., Thompson (of Kansas City), Burdick and he revived; the temperature 100°, pulse 140. McClintock. The evening temperature normal and remain
Dr. Minney in the chair. ed so except once; the 30th it reached 100°.
The minutes of the last meeting were read The external wound healed nicely and the and approved. sutures were removed.
Drs. F. E. Schenck, of Harveyville, and W. October 29-The pulse and temperature the R. Roup, of Arvonia, were elected members same as the 28th, but he became unconscious of the Society, and signed the constitution and and remained so until death.
by-laws, and paid the initiation fees and one October 30—The left parotid began to swell year's dues, $3 in all. increasing rapidly in size, evidently due to
Dr. Schenck read a paper on “ Pruritus," septæmia.
which will appear in the next number of the There was no trace of pus in the wound and JOURNAL. realizing that my patient was too weak to The paper was discussed by all the members stand a second operation nothing further was present. done.
Dr. Schenck, of Harveyville, in discussing October 31—The right parotid gland began the paper, said he had a case in a blacksmith, swelling. The urine was voided, pulse 160. of middle age, in which it was always worse in
November 1-He became maniacal. It re- the winter. quired large doses of morphia and constant Dr. Righter reported a case in which the care to keep him in bed.
patient had pruritus, confined to the perineum November 2—He died at 8 a. m., just seven and back part of the scrotum for five years, and one-half days after receiving the injury. resisting all treatment so far.
Autopsy-Bowels distended with gas and Dr. Righter read a paper on “Stricture of slightly adherent to the peritoneum in places. the Urethra, Diagnosis and Treatment." PubThe stomach was distended with gas and lished in this number of the JOURNAL. water, the wound healing nicely, and sutures Dr. Thompson-In many cases electricity intact.
is beneficial in passing a catheter in strictures The spleen was very friable and adhered to of the urethra. The Doctor spoke at some the stomach with patches of pus between. length on urethral chill and fever following The liver was slightly adhered to the periton the passing of a bougie or catheter. One case eum in places, and there were several small coming under his observation while in the patches of pus on its upper surface, also at hospital, was that of a man who had retenthe points of adhesion to the diaphragm. tion of urine from traumatic stricture, a
The pus and adhesions on the liver, spleen catheter was passed with some difficulty, and and diaphragm, were evidently due to the the bladder was emptied. The man passed liquid contents of the stomach, which escaped his water the next morning, contrary to direcduring the act of vomiting.
tions. In one hour he had a chill, the tempH. H. SUTHERLAND, erature running up to 106°. He had deliriun. LIBERAL, KANSAS.
At 2, p. 11., he awoke and spoke rationally,
and in one-half hour died. SECURE one of the premiums offered by
Dr. Burdick reported a case of supra-pubic the JOURNAL
lithotomy he had witnessed at Guy's Hospital,
performed by Dr. Lucas. He said everything Wilson County Medical Society. was accomplished by this operation that could be by the old method, and its simplicity and The first quarterly meeting for 1890, of the freedom from danger as compared with the Wilson County Medical Society was held at former was not to be compared.
Fredonia, Kansas, January 14th, 1890, Dr. J. The report on a new antiseptic, by Dr. R. Willits presiding. Thompson, and a case of malarial keratitis, by Dr. T. Blakeslee, of Neodosha, and Dr. M. Dr. Minney, was read by title. Both will
A. Duncan, of Buxton, were elected to mempear in the JOURNAL.
bership in the society. Dr. Schenck did the handsome thing of the
Dr. A. N. Perkins, of Fredonia, read a paevening, by feeding the hungry visitors at the per on “Cerebral and Abdominal Surgery," Everett House.
in which he discussed at some length improveattendance at the meeting was small, ments in antiseptic methods. owing to so much "grippe" in the various por
Dr. A. C. Flack, of Fredonia, presented a tions of the Society's bounds—two or three report of a case of acute articular rheumaphysicians in Osage City being its victims. tism in which endocarditis preceded the de
Adjourned to meet in Topeka the second velopment of the disease in the joints. Tuesday of April, 1890.
Dr. F. M. Wiley, of Fredonia, contributed a J. C. McCLINTOCK,
paper on "Typho Malarial Fever," in which Secretary pro. tem.
he attempted to show that the term is unscientific and unnecessary, and should be dis
carded from our nomenclature. Academy of Medicine and Surgery. In the discussion which followed, Dr. T. F.
C. Dodd stated that he treated a case of tyThe Academy of Medicine and Surgery, of phoid fever in Wilson county in 1872, and it Topeka, met in regular session January 7, was the opinion of all present that the disease 1890, at 8 o'clock, p. m.
had had no existence in the county previous Present-Doctor Munn, president; Dr. D. F. to that time. Rodgers, secretary, and Drs. H. C. Miner, D. The committee on Necrology presented an K. Longshore, S. G. Stewart, W. S. Lindsay, appropriate report on the death of Dr. R. B. J. E. Minney, R. E. McVey, C. A. McGuire Campfield, a former member of the society, and J. C. McClintock.
who died at Buffalo, Kansas, November 10, Visitors-Dr. C. H. Mutz, Mrs. Henshaw 1889. The report was adopted and ordered and Mr. Gilbert.
to be published in the local papers. The courtesies of the floor were extended
Dr. J, R. Willits, retiring president, read an to Dr. Mutz.
address upon “Hemorrhages." The minutes of the last meeting were read The following officers were elected for the and approved.
ensuing year: Dr. H. T. McLaughlin, a graduate of the President-A. N. Perkins, M. D. Iowa Medical College, class of 1881, was pro- Vice-President-F. T. Allen, M. D. posed for membership, and referred to board
Secretary and Treasurer-A. C. Flack, M. D. of censors.
Board of Censors—T. Blakeslee, M. Đ., M. Dr. Theo. W. Peers read' a paper on the A. Duncan, M. D., F. M. Wiley, M. D. "History and Diagnosis of Scarlet Fever," On motion, the society adjourned. which will be published in the next issue of In the evening the members of the society the JOURNAL, with the discussion.
with invited guests to the number of about Dr. McClintock will read a paper the next one hundred, assembled at Willit's opera hall, evening, subject to be sent in.
where a magnificent banquet had been preDr. Minney will read a paper on “The pared, and where the evening was spent in Failure of Eyesight, as a Diagnostic Sign Dur- feasting and toasting, and pleasant social ining Pregnancy, and its Treatment."
tercourse. D. F. RODGERS, Secretary'. Although this society has been in existence